Young Smokers' Therapy Preferences: App-Based vs. Face-to-Face Treatment in the Context of Co-Addictions

Background: Tobacco use remains a major public health concern among young adults and is often complicated by co-occurring addictive behaviors. Objective: This study analyzed motivation for change, assessed with the decisional balance framework, in relation to multiple addictions among young smokers seeking treatment. Methods: Ninety-eight participants from the University of Granada enrolled in either an app-based cognitive-behavioral therapy (CBT) program (n = 35) or a traditional face-to-face CBT program (n = 63). Recruitment relied on self-identification and voluntary participation. Standardized instruments were applied to measure nicotine dependence (FTND), behavioral and substance-related addictions (MULTICAGE CAD-4), cannabis dependence (SDS), and motivation for change (DBQ). Logistic and stepwise regression analyses were conducted to identify predictors of treatment choice and motivational outcomes. Results: Younger participants and students were more likely to choose the app-based program. Compulsive buying was linked to perceiving more disadvantages of smoking, whereas sex addiction, cannabis dependence, and other substance addictions were associated with perceiving fewer disadvantages. Conclusions: Treatment preferences and motivational profiles differ according to age, academic status, and co-occurring addictions. These findings highlight the need to tailor smoking cessation strategies to individual profiles and support the role of mobile health tools in engaging digitally oriented populations.